Pennsylvania Rehab Lp - Fort Worth Nursing Home
General Information
UPDATEFederal Provider Number
675034
Provider Name
PENNSYLVANIA REHAB LP
Provider Address
901 PENNSYLVANIA AVE
FORT WORTH, TX 76104
FORT WORTH, TX 76104
Provider Phone Number
(817) 335-3030
Provider SSA County
910
Provider County Name
Tarrant
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
123
Number of Residents in Certified Beds
88
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PENNSYLVANIA REHAB LP
Date First Approved to Provide Medicare and Medicaid services
1992-03-16
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.95511
Reported LPN Staffing Hours per Resident per Day
0.81250
Reported RN Staffing Hours per Resident per Day
0.25966
Reported Licensed Staffing Hours per Resident per Day
1.07216
Reported Total Nurse Staffing Hours per Resident per Day
4.02727
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10057
Expected CNA Staffing Hours per Resident per Day
2.08392
Expected LPN Staffing Hours per Resident per Day
0.56537
Expected RN Staffing Hours per Resident per Day
0.93655
Expected Total Nurse Staffing Hours per Resident per Day
3.58584
Adjusted CNA Staffing Hours per Resident per Day
3.47947
Adjusted LPN Staffing Hours per Resident per Day
1.19280
Adjusted RN Staffing Hours per Resident per Day
0.20716
Adjusted Total Nurse Staffing Hours per Resident per Day
4.52712
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-10-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-10-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
41.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
2016
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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